Diagnosing ‘Strange Spells’

Dear Dr. Roach: I have been having weird spells for about six months. They occur only occasionally and last a couple of days and nights. They awaken me out of sleep and are a little frightening. It starts with a burning sensation on the right side of my nose. I feel as if I have to remember something, and a wave of warmth floods over my upper torso, down to my arms. I feel my heart fluttering, and am a little sick to my stomach. I also have funny sensations in my right ear. It lasts a few seconds, and I just have to ride it out. When it’s over, I feel weak for a while.

I saw a neurologist, who mentioned that it might be anxiety, which made me mad — being awakened out of a sound sleep doesn’t seem to me that I am anxious, as I have no trouble sleeping! He wanted to put me on a medication with a lot of side effects, such as dizziness and hallucinations. I do not want to be on medication, but I also don’t want to have a grand mal seizure. He could not tell me if I could have one or not. I only want affirmation that I am not crazy! — L.G.

Answer: You aren’t crazy. Your neurologist may be right — this can be related to anxiety — but I wouldn’t jump to that diagnosis without considering a few things first.

A warm sensation over different parts of your body should make your doctor think of conditions like carcinoid syndrome and pheochromocytoma. These are tumors that secrete hormone-like substances that can cause odd feelings, such as flushing or warmth, in different parts of the body. They can be screened for with simple urine and blood tests. I agree with you that being awakened with this sensation makes anxiety or panic attack less likely. It does not sound like a seizure disorder to me.

Sometimes, people notice sensations that defy medical explanation. In that case, we generally just try to make sure it isn’t something that threatens life or health and help people minimize and live with the symptoms.

Dear Dr. Roach: I have a problem that I am embarrassed to discuss with my doctor. When I am going to the bathroom and straining with a bowel movement, often recently I will have a major cramp in my abdomen. It used to always occur slightly below my belly button, but now it has moved lower and sometimes to my left side. The cramp is very severe and can be felt and seen on my body surface. Is this something I can do anything about? — L.S.

Answer: Don’t be embarrassed. Your doctor needs to know, and needs to do an exam to feel what might be going on. It could be your normal physiology; it could be mild irritable bowel syndrome. It might be a hernia, especially if it can be seen on your body. Doctors aren’t easily embarrassed, and have heard complaints much, much worse than that.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.